Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1997
Case ReportsIntraoperative convulsions in a child with arthrogryposis.
A case of intraoperative convulsions occurring in a child with arthrogryposis multiplex congenita is presented. Arthrogryposis and the anaesthetic management of children with this condition is discussed. Factors which may have contributed to the convulsions are considered.
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Anaesth Intensive Care · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialEpidural infusion of bupivacaine 0.0625% plus fentanyl 3.3 micrograms/ml provides better postoperative analgesia than patient-controlled analgesia with intravenous morphine after gynaecological laparotomy.
One hundred and twenty women undergoing gynaecological abdominal operations were randomized to receive either epidural bupivacaine 0.0625% + fentanyl 3.3 micrograms/ml infusion (Group EPI, n = 57), or patient-controlled intravenous morphine analgesia (Group PCA, n = 54) for postoperative pain relief. The groups were comparable in demographic data, types and duration of operation. Group EPI achieved significantly lower verbal rating scale of pain (VRS) at rest at 0, 4, 12, 16, 20, 28 and 40th postoperative hours. ⋯ Nausea/vomiting occurred in 52.6%/33.3% of patients in Group EPI and 52.7%/37.0% in Group PCA. Most patients (84.2% in Group EPI and 72.2% in Group PCA) rated their pain management as "good". We conclude that epidural infusion of bupivacaine 0.0625% and fentanyl 3.3 micrograms/ml provide better analgesia than patient-controlled intravenous morphine after gynaecological laparotomy.
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Anaesth Intensive Care · Oct 1997
Multicenter StudyAnalgesia following thoracotomy: a survey of Australian practice.
This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. ⋯ Over half of the respondents reported that post-thoracotomy patients are nursed in a high-dependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently.
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A study was conducted in an attempt to devise a simple and more accurate method of predicting difficult intubation. Prospective assessments were made in 282 patients and retrospective assessment in 16 patients with regard to 21 anatomical factors which were correlated with the laryngoscopic view at intubation. Twelve factors correlated significantly with difficult intubation. ⋯ A scoring system was devised, assigning points to each variable based on its discriminative value. A score of 6 or more correctly identified 22 out of the 23 difficult intubations and there were 50 false positives (sensitivity, specificity and PPV of 96%, 82% and 31% respectively). When negative scoring was done for factors favouring easy intubation, false positives were reduced to 36, but only 20 difficult cases could be identified correctly.